[Stress urinary incontinence treatment with modified technique tension-free vaginal tape obturator]. / Tratamiento de la incontinencia urinaria de esfuerzo con la técnica de cinta vaginal libre de tensión transobturadora modificada.

OBJECTIVE: To evaluate the trans and postoperative complications and surgical results of Tension Free Vaginal Tape Obturator System (TVT-O) for stress urinary incontinence treatment in Angeles del Pedregal Hospital in a five year follow-up. MATERIAL AND METHODS: A retrospective, descriptive case series study with 67 patients was conducted in the Urogynecology Clinic in Hospital Angeles del Pedregal between January 2006 and December 2012. Patients with stress urinary incontinence treated by TVT-O were included. Complications and efficacy of the treatment are described in a 5 year follow-up. RESULTS: 29.9% of the patients had the urodynamic diagnosis of stress incontinence. The 55.2% of them had no other procedure done than the TVT-O. No transoperative complications were observed, but in the postoperative period, 2 (3.%) patients had urinary retention secondary to overcorrected urethra and 1 (1.5%) with intense groin pain. Two cases (3%) presented tape erosion to vagina at 18 months follow-up, with less than 5mm exposure areas. Average follow-up time was 2 years. 46.26% of patients completed a 5 years follow-up. Subjective and objective cures were obtained in all 67 patients. CONCLUSIONS: Tension free vaginal tape obturator system is a minimally invasive procedure that has excellent results (above 95%) in the treatment of stress urinary incontinence with a low rate of complications. Currently, it can be considered as the gold standard surgical treatment for stress urinary incontinence.

[Mechanical changes of the detrusor after antiincontinence surgery]. / Cambios mecánicos del detrusor posteriores a la corrección quirúrgica de la incontinencia urinaria genuina de esfuerzo.

BACKGROUND: Stress urinary incontinence is secondary to an intrinsic defect in the closure or a lack of urethral support; the treatment is surgical and this may affect vesical voiding by creating an obstruction, modifying the contraction power at opening and the mechanical properties of the detrusor. OBJECTIVES: To know if there are changes in the contractile characteristics of the detrusor in order to maintain an efficient voiding after surgical correction of the urinary incontinence. MATERIAL AND METHODS: This was a cohort study of the urodynamic variables, mechanical work and energy of the detrusor, during cystometric and pressure-flow analysis, before and after antiincontinence surgery. Forty-five patients were included with urodynamic study before surgery and another one between 6 weeks and 6 months. We analyzed these data using student T test and ANOVA. RESULTS: The average and maximum flow rates, voiding efficient and velocity of the detrusor decreased. The pressures of the detrusor, the opening power and energy increased significantly after the surgery. These changes were more important in the Burch group. The 24.4% of the patients presented de novo hyperactive bladder; before surgery these patients had detrusor's pressures, voiding power and energy significantly greater. CONCLUSION: There are changes in the mechanical properties of the detrusor after antiincontinence surgery; the detrusor needs a greater energy output to defeat urethral resistance and to maintain the vesical voiding, these were better in patients with Burch procedure and with overactive bladder.

[Urolithiasis and pregnancy. Presentation of results and management norm at the National Institute of Perinatology]. / Urolitiasis y embarazo. Presentación de resultados y norma de manejo en el Instituto Nacional de Perinatología.

AIMS: Urolithiasis associated to pregnancy has an incidence of 1:1,500. It is more frequent in multiparity patients and is a risk factor for preterm labor in more than 40%. OBJECTIVES: To know the incidence of urolithiasis associated to pregnancy at the National Institute of Perinatology; to determine the prevalence of: symptoms and signs, hydronephrosis, urinary tract infections, uropathogens, use of catheters and perinatals results. METHODS: A cohort study was made from January 1998 to October 2003, to identify pregnant patients with urolithiasis. The clinical files were reviewed; Fisher's exact test was used for statistical analysis. RESULTS: Twenty-one patients were diagnosed with urolithiasis; 71% had lumbar pain; 57.1% hematuria; 47.6% bilateral urolithiasis; and 33% bilateral hydronephrosis. All the patients who had lumbar pain, hematuria or were catheterized developed urinary tract infection, even with antibiotics prophylaxis. The 52.4% had at least one urinary tract infection episode. The average gestational age at birth was 38.5 weeks (+/- 5.6 weeks). The 84.22% were preterm births. CONCLUSION: Our incidence is similar to the one reported in the literature. The 71.26% has at least one of the symptoms from the classic triad of urolithiasis. The prevalence of urinary tract infection in these patients is very high therefore; antibiotics prophylaxis and urine cultures are required. A lower prevalence of preterm births was obtained. A flow chart for diagnosis and follow-up was presented in order to decrease and to face the possible complications of this pathologic entity.

[Low urinary tract infection and cystoscopic findings in Urogynecology Service in the Instituto Nacional de Perinatología]. / Infección de vías urinarias bajas y hallazgos cistoscópicos en el Servicio de Uroginecología del Instituto Nacional de Perinatología.

INTRODUCTION: The pathogenesis of urinary tract infection and related to the host and pathogens. There are three associated factors: incontinence, cystocele and residual urine. OBJECTIVES: To know the prevalence of urinary tract infections and uropathogens in urogyneacologic patients of the Instituto Nacional de Perinatología describe the cystoscopic findings in patients with positive urocultures and antibiogram. METHODS: This is a retrospective study involving urogyneacologic patients with positive urine cultures from 1998 to 2001. Positive culture was a growth of only one microorganism more than 100,000 colonies. The antibiogram and patients files were reviewed in order to know: Symptoms, indications, diagnostic and cystoscopic findings; their distribution and differences were analyzed. RESULTS: From 3,433 urine cultures, 540 were positive (16% prevalence). Uropathogens distribution was: E. coli 70%, Klebsiella pneumoniae 6.3%, Pseudomonas aeruginosa 4.3%. The antibiogram showed resistance to beta-lactamics and third generation cephalosporin (96.59% and 85.17%). The most frequent indications were: incontinence, irritative symptoms, urethral hypermovility and pelvic organ prolapse. Urethrothrigonitis was the most frequent cystoscopic finding. Mixed urinary incontinence and urethral hypermotility were the only findings to have a important difference. CONCLUSIONS: There is a change in the uropathogens prevalence and in their antibiotic resistance. This must be considering in the treatment of urogyneacologic patients with urinary tract infections. To ensure the best outcome we must ask for a urine culture with antibiogram. The additional use of anti-inflammatory agents is convenient in the presence of urethrothrigonitis in urogyneacologic patients with urinary tract infections.